Pharmacogenetics for safe codeine use in sickle cell disease

Some experts have called for codeine use be discontinued in all pediatric patients, following the postoperative deaths of children who presented an unpredictable pharmacogenetic response to the drug.

Some experts have called for codeine use be discontinued in all pediatric patients, following the postoperative deaths of children who presented an unpredictable pharmacogenetic response to the drug. Others consider this action too hasty, as it would limit treatment options for certain patients—including those with sickle cell disease—who could actually benefit from the medication. Rather, researchers have come up with a medication safety strategy designed to prevent adverse events from codeine use. The approach takes into account metabolizer status for cytochrome P450 2D6 (CYP2D6), which caused the pediatric deaths and also is an indicator of poor analgesic response. Under the new protocol, interruptive alerts would stop caregivers from prescribing codeine—the only remaining Schedule III opioid analgesic in the United States—to children who may absorb the drug too quickly, or not fast enough. Of 2,468 children, including 830 with sickle cell disease, for whom genotypes were reported as of June 15, 2015, no ultra-rapid or poor metabolizers were given codeine; but those not at high risk were able to be safely treated with it.